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Article History

Received: 24 June 2025

Accepted: 25 November 2025

First Online: 11 December 2025

Declarations

:

: This study used a dataset made available through a data sharing agreement between the Public Health Agency of Canada and Statistics Canada. The study protocol was performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki.

: Not applicable.

: Participants (or their parents/guardians) provided informed consent for their data to be collected by Statistics Canada and shared with the Public Health Agency of Canada for research and statistical purposes, in accordance with the Statistics Act and applicable federal legislation. The legislative authority for the use of de-identified secondary data for public health surveillance or research in Canada is provided by Section 4  of the Department of Health Act and Section  of the Public Health Agency of Canada Act . Therefore, no further consent to participate was required.

: The authors declare no competing interests.

: As per Article 2.2 of Canada’s Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2), research that relies exclusively on secondary use of anonymous information does not require Research Ethics Board (REB) review. The data used in this study consisted of de-identified secondary data accessed through a legislated and regulated mechanism legally protected by Statistics Canada. All researchers with access to the data were employees of the Public Health Agency of Canada and had obtained, at a minimum, Reliability Status as outlined in the Policy on Government Security. No identifiable personal information was accessible, and the analyses conducted did not allow identification of individual participants. Therefore, REB approval was not required for this study.